AIM:To assess effectiveness, complications, recurrence rate, and recent improvements of the anterior rectopexy procedure for treatment of total rectal prolapse.METHODS:MEDLINE, Pub Med, EMBASE, and other relevant data...AIM:To assess effectiveness, complications, recurrence rate, and recent improvements of the anterior rectopexy procedure for treatment of total rectal prolapse.METHODS:MEDLINE, Pub Med, EMBASE, and other relevant database were searched to identify studies.Randomized controlled trials, non-randomized studies and original articles in English language, with more than 10 patients who underwent laparoscopic ventral rectopexy for full-thickness rectal prolapse, with a follow-up over 3 mo were considered for the review.RESULTS:Twelve non-randomized case series studies with 574 patients were included in the review.No surgical mortality was described.Conversion was needed in 17 cases(2.9%), most often due to difficult adhesiolysis.Twenty eight patients(4.8%) presented with major complications.Seven(1.2%) mesh-related complications were reported.Most frequent complications were urinary tract infection and urinary retention.Mean recurrence rate was 4.7% with a median follow-up of 23 mo.Improvement of constipation ranged from 3%-72% of the patients and worsening or new onset occurred in 0%-20%.Incontinence improved in 31%-84% patients who presented fecal incontinence at various stages.Evaluation of functional score was disparate between studies.CONCLUSION:Based on the low long-term recurrence rate and favorable outcome data in terms of low de novo constipation rate, improvement of anal incontinence, and low complications rate, laparoscopic anterior rectopexy seems to emerge as an efficient procedure for the treatment of patients with total rectal prolapse.展开更多
BACKGROUND Abdominal ventral rectopexy(AVR)with colectomy is controversial in the treatment of obstructed defecation syndrome(ODS).Literature data on this technique for ODS are very limited.AIM To evaluate the safety ...BACKGROUND Abdominal ventral rectopexy(AVR)with colectomy is controversial in the treatment of obstructed defecation syndrome(ODS).Literature data on this technique for ODS are very limited.AIM To evaluate the safety and efficacy of AVR with colectomy for selected patients with ODS.METHODS Consecutive patients who underwent AVR with colectomy for ODS were identified prospectively from 2016 to 2017 in our department.Patient demographics,perioperative surgical results,and postoperative follow-up outcomes were collected and analyzed.Long-term follow-up was evaluated with standardized questionnaires.The severity of symptoms was assessed by the objective Wexner Constipation Score(WCS)and ODS Score.The quality of life was assessed by the Patients Assessment of Constipation Quality of Life score.Functional outcome was compared pre-and post-operatively for each patient.The primary outcomes were determined by the improvement in symptoms and quality of life.Secondary outcome measures were operating time,postoperative length of stay,morbidity and mortality,improvement of pelvic floor structure,and patient satisfaction.RESULTS Four patients underwent robotic-assisted surgery,and two patients underwent a laparoscopic-assisted procedure.The mean operating time for the robotic approach was 243 min(range 160–300 min),and the mean operating time for the laparoscopic approach was 230 min(range 220-240 min).The mean postoperative length of stay was 8.2 d(range 6-12 d).There was no conversion to open procedure and no postoperative mortality.No urinary retention,wound infection,prolonged ileus,pelvic infection and anastomosis leakage occurred.Six patients were followed up for 36 mo.The WCS,ODS,and Patients Assessment of Constipation Quality of Life score improved significantly postoperatively(P<0.05).The WCS and ODS scores showed the best remission and stabilization at 6 to 12 mo after surgery.There was no recurrence or novel constipation after surgery.None of the patients used laxative medication.CONCLUSION Robotic and laparoscopic-assisted ventral rectopexy with colectomy is a safe and effective procedure for selected patients with ODS.However,comprehensive preoperative evaluation and careful patient selection are essential.展开更多
External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal proced...External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal procedures are associated with a higher recurrence rate, an abdominal approach is commonly preferred. Despite the description of greater than three hundred different procedures, thus far no clear superiority of one surgical technique has been demonstrated. Ventral mesh rectopexy(VMR) is a relatively new and promising technique to correct rectal prolapse. In contrast to the abdominal procedures of past decades, VMR avoids posterolateral rectal mobilisation and thereby minimizes the risk of postoperative constipation. Because of a perceived acceptable recurrence rate, good functional results and low mesh-related morbidity in the short to medium term, VMR has been popularized in the past decade. Laparoscopic or robotic-assisted VMR is now being progressively performed internationally and several articles and guidelines propose the procedure as the treatment of choice for rectal prolapse. In this article, an outline of the current status of laparoscopic and robotic ventral mesh rectopexy for the treatment of internal and external rectal prolapse is presented.展开更多
AIM: To analyze the outcomes of laparoscopic ventral mesh rectopexy in the management of complete rectal prolapse(CRP) in North Indian patients with inherent bulky and redundant colon. METHODS: The study was conducted...AIM: To analyze the outcomes of laparoscopic ventral mesh rectopexy in the management of complete rectal prolapse(CRP) in North Indian patients with inherent bulky and redundant colon. METHODS: The study was conducted at a tertiary health care center of North India. Between January 2010 and October 2014, 15 patients who underwent laparoscopic ventral mesh repair for CRP, were evaluated in the present study. Perioperative outcomes, improvement in bowel dysfunction or appearance of new complications were documented from the hospital records maintained prospectively. RESULTS: Fifteen patients(9 female) with a median age of 50 years(range, 15-68) were included in the study. The median operative time was 200 min(range, 180-350 min) and the median post-operative stay was 4 d(range, 3-21 d). No operative mortality occurred. One patient with inadvertent small bowel injury required laparotomy on post-operative day 2. At a median follow-up of 22 mo(range, 4-54 mo), no prolapse recurrence was reported. No mesh-related complication was encountered. Wexner constipation score improved significantly from the preoperative value of 17(range, 5-24) to 6(range, 0-23)(P < 0.001) and the fecal incontinence severity index score from 24(range, 0-53)to 2(range, 0-53)(P = 0.007). No de novo constipation or fecal incontinence was recorded during the followup. On personal conversation, all patients expressed satisfaction with the outcome of their treatment. CONCLUSION: Our experience indicates that laparoscopic ventral mesh rectopexy is an effective surgical option for CRP in North Indian patients having a bulky redundant colon.展开更多
BACKGROUND Laparoscopic ventral mesh rectopexy(LVMR)continues to be a popular treatment option for rectal prolapse,obstructive defecation/faecal incontinence and rectoceles.In recent years there have been concerns reg...BACKGROUND Laparoscopic ventral mesh rectopexy(LVMR)continues to be a popular treatment option for rectal prolapse,obstructive defecation/faecal incontinence and rectoceles.In recent years there have been concerns regarding the safety of mesh placements in the pelvis.AIM To assess the safety of the mesh and the outcome of the procedure.METHODS Eighty-six patients underwent LVMR with Permacol(Biological)mesh from 2012 to 2018 at University Hospital Wishaw.Forty were treated for obstructive defecation secondary to prolapse,rectocele or internal rectal intussusception,38 for mixed symptoms obstructive defecation and incontinence,5 for pain and bleeding secondary to full thickness prolapse and 3 with symptoms of incontinence.Questionnaires for the calculation of Wexner scores for constipation and incontinence were completed by the patients who were followed up in the clinic 12 wk after surgery and again in 6-12 mo.The average review of their notes was 18.3±4.2 mo.RESULTS The median Wexner scores for constipation pre-operatively and post-operatively were 14.5[Interquartile range(IQR):10.5-18.5]and 3(IQR:1-6),respectively,while the median Wexner score for faecal incontinence was 11(IQR:7-15)and 2(IQR:0-5),respectively(P<0.01).There were 4(4.6%)recurrences,2 cases that presented with erosion of a suture through the rectum and one with diskitis.No mesh complications or mortalities were recorded.CONCLUSION LVMR using a Permacol mesh is a safe and effective procedure for the treatment of obstructive defecation/faecal incontinence,rectal prolapse,rectoceles and internal rectal prolapse/intussusception.展开更多
Introduction: Rectal prolapse is a relatively common, usually self-limiting illness in children. Peak incidence is between 1 and 3 years. The intervention is required for the persistent rectal prolapse (PRP). Only sca...Introduction: Rectal prolapse is a relatively common, usually self-limiting illness in children. Peak incidence is between 1 and 3 years. The intervention is required for the persistent rectal prolapse (PRP). Only scanty experience is available with laparoscopic rectopexy in children. There is no available work using both mesh and suture laparoscopic rectopexy in literature. This work is unique that it presents our clinical experience with both mesh and suture laparoscopic rectopexy in children. This is a prospective clinical study for the outcome of laparoscopic rectopexy (LRP) by both mesh and suture technique in children with persistent rectal prolapse (PRP). Materials and Methods: Fourteen cases of PRP were managed with LRP from February 2008 to August 2012. Results: Of the 14 children, 10 (71.42%) were males and 4 (28.57%) were females. Male to female ratio was 2:1. The mean age of presentation was 5 years (range 3 - 8 years). The presenting complaints were mass descending per rectum along with bleeding per rectum lasting from 1 to 3 years. All had rectal prolapse of 5 - 7 cm in length. 12 out of 14 children had recurrence even after sclerotherapy before referral to laparoscopic rectpexy. The mean duration of surgery was 30 minutes (range 20 - 60 minutes). No intraoperative complications were reported;only one case got constipation and was managed conservatively and no recurrence. Conclusion: LRP is safe, feasible in children and gives satisfactory results after failure of all conservative even sclerotherapy injection.展开更多
Pelvic floor disorders are different dysfunctions of gynaecological, urinary or anorectal organs, which can present as incontinence, outlet-obstruction and organ prolapse or as a combination of these symptoms. Pelvic ...Pelvic floor disorders are different dysfunctions of gynaecological, urinary or anorectal organs, which can present as incontinence, outlet-obstruction and organ prolapse or as a combination of these symptoms. Pelvic floor disorders affect a substantial amount of people,predominantly women. Transabdominal procedures play a major role in the treatment of these disorders. With the development of new techniques established open procedures are now increasingly performed lapa-roscopically. Operation techniques consist of various rectopexies with suture, staples or meshes eventually combined with sigmoid resection. The different approaches need to be measured by their operative and functional outcome and their recurrence rates. Although these operations are performed frequently a comparison and evaluation of the different methods is difficult, as most of the used outcome measures in the available studies have not been standardised and data from randomised studies comparing these outcome measures directly are lacking. Therefore evidence based guidelines do not exist. Currently the laparoscopic approach with ventral mesh rectopexy or resection rectopexy is the two most commonly used techniques. Observational and retrospective studies show good functional results, a low rate of complications and a low recurrence rate. As high quality evidence is missing, an individualized approach is recommend for every patient considering age, individual health status and the underlying morphological and functional disorders.展开更多
Background:External rectal prolapse is a relatively rare disease,in which male patients account for a minority.The selection of abdominal repair or perineal repair for male patients has rarely been investigated.Method...Background:External rectal prolapse is a relatively rare disease,in which male patients account for a minority.The selection of abdominal repair or perineal repair for male patients has rarely been investigated.Methods:Fifty-one male patients receiving abdominal repair(laparoscopic ventral rectopexy)or perineal repair(Delorme or Altemeier procedures)at the Sixth Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between March 2013 and September 2019 were retrospectively analysed.We compared the recurrence,complication rate,post-operative defecation disorder,length of stay,and quality of life between the abdominal and perineal groups.Results:Of the 51 patients,45 had a complete follow-up,with a median of 48.5 months(range,22.8–101.8 months).A total of 35 patients were under age 40 years.The complication rate associated with abdominal repair was less than that associated with perineal repair(0%vs 20.7%,P=0.031)and the recurrence rate was also lower(9.5%vs 41.7%,P=0.018).Multivariate analysis showed that perineal repair(odds ratio,9.827;95%confidence interval,1.296–74.50;P=0.027)might be a risk factor for recurrence.Moreover,only perineal repair significantly improved post-operative constipation status(preoperative vs post-operative,72.4%vs 25.0%,P=0.001).There was no reported mortality in either of the groups.No patient’s sexual function was affected by the surgery.Conclusions:Both surgical approaches were safe in men.Compared with perineal repair,the complication rate and recurrence rate for abdominal repair were lower.However,perineal repair was better able to correct constipation.展开更多
文摘AIM:To assess effectiveness, complications, recurrence rate, and recent improvements of the anterior rectopexy procedure for treatment of total rectal prolapse.METHODS:MEDLINE, Pub Med, EMBASE, and other relevant database were searched to identify studies.Randomized controlled trials, non-randomized studies and original articles in English language, with more than 10 patients who underwent laparoscopic ventral rectopexy for full-thickness rectal prolapse, with a follow-up over 3 mo were considered for the review.RESULTS:Twelve non-randomized case series studies with 574 patients were included in the review.No surgical mortality was described.Conversion was needed in 17 cases(2.9%), most often due to difficult adhesiolysis.Twenty eight patients(4.8%) presented with major complications.Seven(1.2%) mesh-related complications were reported.Most frequent complications were urinary tract infection and urinary retention.Mean recurrence rate was 4.7% with a median follow-up of 23 mo.Improvement of constipation ranged from 3%-72% of the patients and worsening or new onset occurred in 0%-20%.Incontinence improved in 31%-84% patients who presented fecal incontinence at various stages.Evaluation of functional score was disparate between studies.CONCLUSION:Based on the low long-term recurrence rate and favorable outcome data in terms of low de novo constipation rate, improvement of anal incontinence, and low complications rate, laparoscopic anterior rectopexy seems to emerge as an efficient procedure for the treatment of patients with total rectal prolapse.
基金Supported by National Natural Science Foundation of China,No.81570483 and 81770541Technology Innovation Project of Chongqing,No.cstc2019jscxmsxmX0227 and cstc2015shmszx120109.
文摘BACKGROUND Abdominal ventral rectopexy(AVR)with colectomy is controversial in the treatment of obstructed defecation syndrome(ODS).Literature data on this technique for ODS are very limited.AIM To evaluate the safety and efficacy of AVR with colectomy for selected patients with ODS.METHODS Consecutive patients who underwent AVR with colectomy for ODS were identified prospectively from 2016 to 2017 in our department.Patient demographics,perioperative surgical results,and postoperative follow-up outcomes were collected and analyzed.Long-term follow-up was evaluated with standardized questionnaires.The severity of symptoms was assessed by the objective Wexner Constipation Score(WCS)and ODS Score.The quality of life was assessed by the Patients Assessment of Constipation Quality of Life score.Functional outcome was compared pre-and post-operatively for each patient.The primary outcomes were determined by the improvement in symptoms and quality of life.Secondary outcome measures were operating time,postoperative length of stay,morbidity and mortality,improvement of pelvic floor structure,and patient satisfaction.RESULTS Four patients underwent robotic-assisted surgery,and two patients underwent a laparoscopic-assisted procedure.The mean operating time for the robotic approach was 243 min(range 160–300 min),and the mean operating time for the laparoscopic approach was 230 min(range 220-240 min).The mean postoperative length of stay was 8.2 d(range 6-12 d).There was no conversion to open procedure and no postoperative mortality.No urinary retention,wound infection,prolonged ileus,pelvic infection and anastomosis leakage occurred.Six patients were followed up for 36 mo.The WCS,ODS,and Patients Assessment of Constipation Quality of Life score improved significantly postoperatively(P<0.05).The WCS and ODS scores showed the best remission and stabilization at 6 to 12 mo after surgery.There was no recurrence or novel constipation after surgery.None of the patients used laxative medication.CONCLUSION Robotic and laparoscopic-assisted ventral rectopexy with colectomy is a safe and effective procedure for selected patients with ODS.However,comprehensive preoperative evaluation and careful patient selection are essential.
文摘External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal procedures are associated with a higher recurrence rate, an abdominal approach is commonly preferred. Despite the description of greater than three hundred different procedures, thus far no clear superiority of one surgical technique has been demonstrated. Ventral mesh rectopexy(VMR) is a relatively new and promising technique to correct rectal prolapse. In contrast to the abdominal procedures of past decades, VMR avoids posterolateral rectal mobilisation and thereby minimizes the risk of postoperative constipation. Because of a perceived acceptable recurrence rate, good functional results and low mesh-related morbidity in the short to medium term, VMR has been popularized in the past decade. Laparoscopic or robotic-assisted VMR is now being progressively performed internationally and several articles and guidelines propose the procedure as the treatment of choice for rectal prolapse. In this article, an outline of the current status of laparoscopic and robotic ventral mesh rectopexy for the treatment of internal and external rectal prolapse is presented.
文摘AIM: To analyze the outcomes of laparoscopic ventral mesh rectopexy in the management of complete rectal prolapse(CRP) in North Indian patients with inherent bulky and redundant colon. METHODS: The study was conducted at a tertiary health care center of North India. Between January 2010 and October 2014, 15 patients who underwent laparoscopic ventral mesh repair for CRP, were evaluated in the present study. Perioperative outcomes, improvement in bowel dysfunction or appearance of new complications were documented from the hospital records maintained prospectively. RESULTS: Fifteen patients(9 female) with a median age of 50 years(range, 15-68) were included in the study. The median operative time was 200 min(range, 180-350 min) and the median post-operative stay was 4 d(range, 3-21 d). No operative mortality occurred. One patient with inadvertent small bowel injury required laparotomy on post-operative day 2. At a median follow-up of 22 mo(range, 4-54 mo), no prolapse recurrence was reported. No mesh-related complication was encountered. Wexner constipation score improved significantly from the preoperative value of 17(range, 5-24) to 6(range, 0-23)(P < 0.001) and the fecal incontinence severity index score from 24(range, 0-53)to 2(range, 0-53)(P = 0.007). No de novo constipation or fecal incontinence was recorded during the followup. On personal conversation, all patients expressed satisfaction with the outcome of their treatment. CONCLUSION: Our experience indicates that laparoscopic ventral mesh rectopexy is an effective surgical option for CRP in North Indian patients having a bulky redundant colon.
文摘BACKGROUND Laparoscopic ventral mesh rectopexy(LVMR)continues to be a popular treatment option for rectal prolapse,obstructive defecation/faecal incontinence and rectoceles.In recent years there have been concerns regarding the safety of mesh placements in the pelvis.AIM To assess the safety of the mesh and the outcome of the procedure.METHODS Eighty-six patients underwent LVMR with Permacol(Biological)mesh from 2012 to 2018 at University Hospital Wishaw.Forty were treated for obstructive defecation secondary to prolapse,rectocele or internal rectal intussusception,38 for mixed symptoms obstructive defecation and incontinence,5 for pain and bleeding secondary to full thickness prolapse and 3 with symptoms of incontinence.Questionnaires for the calculation of Wexner scores for constipation and incontinence were completed by the patients who were followed up in the clinic 12 wk after surgery and again in 6-12 mo.The average review of their notes was 18.3±4.2 mo.RESULTS The median Wexner scores for constipation pre-operatively and post-operatively were 14.5[Interquartile range(IQR):10.5-18.5]and 3(IQR:1-6),respectively,while the median Wexner score for faecal incontinence was 11(IQR:7-15)and 2(IQR:0-5),respectively(P<0.01).There were 4(4.6%)recurrences,2 cases that presented with erosion of a suture through the rectum and one with diskitis.No mesh complications or mortalities were recorded.CONCLUSION LVMR using a Permacol mesh is a safe and effective procedure for the treatment of obstructive defecation/faecal incontinence,rectal prolapse,rectoceles and internal rectal prolapse/intussusception.
文摘Introduction: Rectal prolapse is a relatively common, usually self-limiting illness in children. Peak incidence is between 1 and 3 years. The intervention is required for the persistent rectal prolapse (PRP). Only scanty experience is available with laparoscopic rectopexy in children. There is no available work using both mesh and suture laparoscopic rectopexy in literature. This work is unique that it presents our clinical experience with both mesh and suture laparoscopic rectopexy in children. This is a prospective clinical study for the outcome of laparoscopic rectopexy (LRP) by both mesh and suture technique in children with persistent rectal prolapse (PRP). Materials and Methods: Fourteen cases of PRP were managed with LRP from February 2008 to August 2012. Results: Of the 14 children, 10 (71.42%) were males and 4 (28.57%) were females. Male to female ratio was 2:1. The mean age of presentation was 5 years (range 3 - 8 years). The presenting complaints were mass descending per rectum along with bleeding per rectum lasting from 1 to 3 years. All had rectal prolapse of 5 - 7 cm in length. 12 out of 14 children had recurrence even after sclerotherapy before referral to laparoscopic rectpexy. The mean duration of surgery was 30 minutes (range 20 - 60 minutes). No intraoperative complications were reported;only one case got constipation and was managed conservatively and no recurrence. Conclusion: LRP is safe, feasible in children and gives satisfactory results after failure of all conservative even sclerotherapy injection.
文摘Pelvic floor disorders are different dysfunctions of gynaecological, urinary or anorectal organs, which can present as incontinence, outlet-obstruction and organ prolapse or as a combination of these symptoms. Pelvic floor disorders affect a substantial amount of people,predominantly women. Transabdominal procedures play a major role in the treatment of these disorders. With the development of new techniques established open procedures are now increasingly performed lapa-roscopically. Operation techniques consist of various rectopexies with suture, staples or meshes eventually combined with sigmoid resection. The different approaches need to be measured by their operative and functional outcome and their recurrence rates. Although these operations are performed frequently a comparison and evaluation of the different methods is difficult, as most of the used outcome measures in the available studies have not been standardised and data from randomised studies comparing these outcome measures directly are lacking. Therefore evidence based guidelines do not exist. Currently the laparoscopic approach with ventral mesh rectopexy or resection rectopexy is the two most commonly used techniques. Observational and retrospective studies show good functional results, a low rate of complications and a low recurrence rate. As high quality evidence is missing, an individualized approach is recommend for every patient considering age, individual health status and the underlying morphological and functional disorders.
基金supported by the Guangdong Medical Research Fund Project[grant number A2021171].
文摘Background:External rectal prolapse is a relatively rare disease,in which male patients account for a minority.The selection of abdominal repair or perineal repair for male patients has rarely been investigated.Methods:Fifty-one male patients receiving abdominal repair(laparoscopic ventral rectopexy)or perineal repair(Delorme or Altemeier procedures)at the Sixth Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between March 2013 and September 2019 were retrospectively analysed.We compared the recurrence,complication rate,post-operative defecation disorder,length of stay,and quality of life between the abdominal and perineal groups.Results:Of the 51 patients,45 had a complete follow-up,with a median of 48.5 months(range,22.8–101.8 months).A total of 35 patients were under age 40 years.The complication rate associated with abdominal repair was less than that associated with perineal repair(0%vs 20.7%,P=0.031)and the recurrence rate was also lower(9.5%vs 41.7%,P=0.018).Multivariate analysis showed that perineal repair(odds ratio,9.827;95%confidence interval,1.296–74.50;P=0.027)might be a risk factor for recurrence.Moreover,only perineal repair significantly improved post-operative constipation status(preoperative vs post-operative,72.4%vs 25.0%,P=0.001).There was no reported mortality in either of the groups.No patient’s sexual function was affected by the surgery.Conclusions:Both surgical approaches were safe in men.Compared with perineal repair,the complication rate and recurrence rate for abdominal repair were lower.However,perineal repair was better able to correct constipation.
